The Donut Hole (or Coverage Gap) begins when the total spent on drugs exceeds $3750

The $3750 total includes the amount spent by you plus the amount spent by your insurance company

The $3750 threshold total does not include monthly premiums paid by you

While in the Donut Hole you will pay only 35% of the negotiated retail price for any Brand name drug that you purchase. When you purchase generic drugs, you will pay 44% of the negotiated retail price unless your specific Part D plan offers a greater discount.

The Donut Hole (Coverage Gap) ends when you have spent a total of $5000 of your own money on drugs (not including the money you spent on monthly premiums)

Once you have spent $5000 of your own money during the year, the catastrophic coverage begins. The individual pays approximately 5% of the cost of the drugs from then on until the end of the year. There is no carry-over from year to year. Each year all plans start anew.

Action Recommended for Evaluating Next Year's Part D Plans (2019)

Step 1 - Call us today for counseling – 781-828-1875

Step 2 – We will evaluate your Part D plan

Step 3 - Make a decision – change plans for next year or stay with present plan

Step 4 - Yes, I wish to change plans - you must enroll anytime between October 15, 2017 and December 7, 2017 or No, I wish to stay with my present Part D plan for 2017 – no action necessary

Everyone should re-evaluate their Part D Plan for the coming year. Plans change and a plan that is suitable this year may be too expensive next year. Our counseling can help.